Is there more of a reason why SUD patients sign out AMA than "they're just not ready"?

 Lately, I have been pondering why patients with substance use disorder tend to leave treatment 'against medical advice' (AMA). Although I am not an authority on the matter, I would like to share my observation.

If a particular patient consistently decides to leave medical treatment, could there be underlying psychological, physical, or emotional issues at play? It is common to categorize the patient as "resistant to treatment" or "not ready," without acknowledging the possibility of deeper, unresolved issues. It is important to consider that there may be underlying factors that are being overlooked.

Is it possible that the person is scared or even terrified of the thought of being sober and facing the childhood trauma that led to their addiction in the first place? Instead of faulting the patient for consistently leaving before completing or starting treatment, let's investigate the underlying reasons for their actions. Instead of blaming them, let's try to understand their perspective and identify the underlying reasons behind their actions. 

By listening to their thoughts and feelings, we can promote healing and develop a deeper understanding of the situation, rather than relying on our assumptions and assigning sole responsibility to them.

Which side will you fight on when a civil war battle breaks out in your detox facility or intake office?

 Have you ever heard something like this when a patient with Substance Use Disorder leaves detox or fails to complete the admissions process:

“They just aren’t ready.”

“They just want to get high.”

If someone willingly came to your facility to start a detox program, you may have said to them:

“I’m so glad you’re ready.”

“I’m glad you're tired of getting high.”

Can you tell me what occurred between the time they entered your facility and when they departed?

A battle in their personal mental Civil War!

That is what has happened right in front of you and inside of them!

Instead of blaming the patient for deviating from their detox plan, focus on supporting the aspect of their mental struggle that brought their entire being - mind, body, and spirit - to your office.

The patient had to exert a great deal of mental effort to come to you, as their thought processes are not functioning as they should. Your mind, on the other hand, is functioning properly.

Choose to take the higher path and do all that you can to support the patient in their ongoing internal battle.

Stand by their side, on the side of the civil war that was prevailing when they arrived at your door.

There's no such thing as a holiday weekend for people trapped in addiction and homelessness.

One day is no different than the previous or the next...

...unless you are a person who is financially reliant on prostitution, more politely known as ‘doing a date’, to raise money for the addiction you would rather not have.

On holiday weekends, men who hire women for acts of prostitution are not here in Kensington nearly as much because they're out with their families at the beach and other locations.

It's a stunningly heartbreaking system we have going here. 

90% of all the women on the streets are 100% reliant on prostitution to raise money for the drug addiction that they would rather not have. 

70% of all the men on the streets are 100% reliant on that 90% of women. 

For the sake of discussion and easy-to-follow math let's assume that the number of men and women are equal...

That means that 80% of the money for drug purchases from the homeless population comes through prostitution.

If we started targeting for arrest the men with the money and not the women with the addiction, we might start seeing an improvement in this nightmare.

If we were to do so, the money source would dry up. The healthcare system would have to step up to the plate with prompt, dignified, and respect-filled professional care.

Let's hope these factors come together someday so that some of this sad nightmare can be resolved.